Quote Of The Year

Timeless Quotes - Sadly The Late Paul Shetler - "Its not Your Health Record it's a Government Record Of Your Health Information"

or

H. L. Mencken - "For every complex problem there is an answer that is clear, simple, and wrong."

Saturday, October 08, 2011

Weekly Overseas Health IT Links - 08 October, 2011.

Note: Each link is followed by a title and few paragraphs. For the full article click on the link above title of the article. Note also that full access to some links may require site registration or subscription payment.
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Firm tries again with personal health records

September 26, 2011
Even though Google Inc. has given up on the business of electronic personal health records, Fort Wayne-based NoMoreClipboard.com is launching a new service it thinks will crack open the market.
The company’s latest service, called cc:Me, gives patients a free and secure web-based account that can receive their electronic medical records from any other system and also can receive new records from any electronic medical record system their doctor or hospital happens to use.
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ONC Explains New Data Analytics Initiative

HDM Breaking News, September 27, 2011
The Office of the National Coordinator for Health Information Technology recently launched Query Health, a new initiative to establish standards and services for distributed population queries of electronic health records.
In a posting on ONC's blog, Doug Fridsma, M.D., director of the office of standards and interoperability, explains Query Health and asks industry participants to join one of three workgroups.
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EHR use can cause docs' skills to diminish

September 29, 2011 — 8:39am ET | By Marla Durben Hirsch - Contributing Editor
While electronic health records may lessen physician workloads, save time and improve patient care, adapting to the technology can lead physicians to perform in a more standardized, compartmentalized and routine way, eventually causing them to lose some of their clinical decision making and other skills.   
That sobering news is from a new study published in the Oct.-Dec. 2011 issue of Health Care Management Review, which found that EHRs may remove critical aspects of physician discretion in everyday work. Essentially, some providers wind up relying more blindly on information from the technology, such as guidelines, rather than their own knowledge and experience, ultimately leading to a "deskilling" process.  
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Malpractice risks can unexpectedly rise with EHR use

September 29, 2011 — 8:38am ET | By Marla Durben Hirsch - Contributing Editor
Electronic health records contain features, such as templates, which can help providers reduce the risk of malpractice litigation. But the misuse of EHRs actually can cause providers to be more vulnerable to such lawsuits, according to a recent article in MDNews.com.  
An EHR's audit trail function, which keeps track of the date and time of all activities performed on the EHR, can become a malpractice liability, the article points out. For example, if a physician treats a patient and weeks later realizes he left information off of the patient's chart and signs on to add it, the date and time of the amendment will be logged on the audit trail, which can be used against him. Or, since the EHR tracks access to the records, if a provider failed to review data--such as test results that had been received--it's relatively easy for the patient's attorney to discover that omission.
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10 IT initiatives your hospital should undertake in 2012

September 28, 2011 | Michelle McNickle, Web Content Producer
A new year means a fresh start, and as 2012 creeps closer, it's time to think about new IT approaches. Although the reform may mandate certain IT practices be implemented, other non-required initiatives will help to streamline workflows, save money and improve care in the new year.
Fred Pennic, senior advisor with Aspen Advisors and author of the blog Healthcare IT Consultant, suggested 10 initiatives hospitals should undertake in 2012. 
1. Meeting Stages 1 and 2 of meaningful use. According to Pennic, meaningful use compliance should be the top priority in health IT during the years to come. "More providers are currently attesting for Stage 1 meaningful use, although it is still unclear if Stage 2 will be delayed until 2014," he said. According to a study published online by Health Affairs, hospitals should be prepared for a higher standard associated with Stage 2 in order to produce improved patient outcomes; authors of the study believe Stages 2 and 3, which will require providers to use electronic orders for 60 to 80 percent of patients, will have a significant impact on both patient mortality rates and care. 
2. Health information exchange (HIE). Meaningful use and HIE go hand in hand, said Pennic. "Interoperability is key as it relates to meaningful use’s objectives of electronically exchanging clinical information and summaries of care, along with submitting lab results to public health agencies, et cetera," he said. Looking for resources or a way to network and learn what others are doing when it comes to HIE? The HIMSS HIE Toolkit and the HIMSS HIE Wiki offer insights and information regarding HIE, including important national and state level initiatives. 
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KLAS Finds Integration, ROI Hamper Homecare Market

Posted by Anthony Guerra on September 28th, 2011
KLAS Finds Homecare Needs Improvement
Best-of-breed vendors tend to score higher than enterprise players across the board in the homecare market for meeting complex CMS regulations, but have little to offer providers in the way of interoperability, according to a new KLAS report, Homecare 2011: New Expectations, New Market Energy.
But even enterprise vendors, which typically have the integration advantage, are “miles” from effectively sharing data electronically with hospitals, the organization found. Said report author Erik Bermudez, “Usually enterprise vendors have an interoperability advantage, but that is not the case yet in homecare. Only a couple of vendors are sharing data with affiliated hospitals and clinics — and even they don’t do it well.”
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Canadian docs in training embrace EMRs

September 29, 2011 | Molly Merrill, Associate Editor
OTTAWA – Future doctors in Canada expect to produce efficiencies in healthcare delivery by expanding the use of electronic medical records in their practice, according to a new survey.
The 2010 National Physician Survey (NPS) included responses from 5,600 medical students and residents.
The survey is Canada’s largest census survey of physicians and physicians‐in‐training and is conducted jointly by the College of Family Physicians of Canada, the Canadian Medical Association and the Royal College of Physicians and Surgeons of Canada.
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Birmingham Women's unhappy with Lorenzo

27 September 2011   Shanna Crispin
Birmingham Women’s NHS Foundation Trust is refusing to sign off on its deployment of Lorenzo because it is not satisfied with the level of functionality delivered.
The trust was the third ‘early adopter’ of the iSoft software, which CSC is trying to deploy to the North, Midlands and East of England as part of the National Programme for IT in the NHS.
It went live with the latest version of the software, Lorenzo Care Management Release 1.9 in November last year, and said at the time that it was “pleased” to have taken such an “important step” although there was “much work to do” as new modules were added.
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Older, busier docs more likely to use novel EHR functionality

September 26, 2011 | Molly Merrill, Associate Editor
BOSTON – Contrary to popular belief, a new study has found that older physicians who are clinically busier and see more complex patients are more likely to use new EHR functionality than younger clinicians.
The findings were determined by researchers at Brigham and Women's Hospital (BWH), who analyzed the intervention arm of a randomized trial of new EHR-based tobacco treatment functionality. The trial included 207 clinicians and the functionality was used by 50 percent, or 103 clinicians.
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EKG data mining helps assess death risk for heart-attack patients: study

Posted: September 29, 2011 - 12:00 pm ET
Data mining of electrocardiogram histories is a key component of a new tool developed by a group of university and hospital researchers to better predict the risk of death in patients who have had a heart attack.
Results of the researchers' study and details of their tool to analyze patients' risk of death after a heart attack are published in the Sept. 28 edition of Science Translational Medicine.

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Sixth Welsh board to put Myrddin live

26 September 2011   Shanna Crispin
A sixth Welsh health board is due to go live with the national patient administration system, Myrddin, following significant delays.
The NHS Wales Informatics Service has told eHealth Insider that Aneurin Bevan Health Board will go live with the NHS Wales-developed PAS in the autumn, after initially intending to launch it over June and July.
The health board, which covers Gwent, is opening the Ysbyty Ystrad Fawr Hospital in the next two months, and will start to move patients to the hospital on November.
An Aneurin Bevan Health Board paper states the PAS needed to be live ahead of that date. However, delays to rolling out the system in other health boards have held up implementation and put the latest possible go-live date in jeopardy.
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Electronic tool helps docs screen for pregnancy problems

September 29, 2011 — 8:33am ET | By Marla Durben Hirsch - Contributing Editor
A tool enabling doctors to electronically take a detailed family history during a woman's first prenatal visit currently is being tested by several hospitals in partnership with the March of Dimes, the organization recently announced. The tool is geared toward helping providers to screen for inherited conditions and preterm birth, as recommended by clinical guidelines.
Patients at participating facilities will fill out a standardized family history questionnaire in their doctor's office using a computerized tablet. The information then will be analyzed electronically, and the tool will provide red flags and recommendations for providers based on current professional guidelines. On the basis of this information, doctors may be prompted to ask the patient more questions, or refer her to a genetic specialist.
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Thursday, September 29, 2011

Data Take Center Stage at Health 2.0 Conference

SAN FRANCISCO -- If the Health 2.0 movement is perceived as an ongoing conversation, the first four years could be seen as determining who was going to be talking and what the means of communication was going to be. Now, in year five, the focus is turning to what, exactly, everybody's going to be talking about.
"Data is everything," said Health 2.0 cofounder Mathew Holt at the Fifth Annual Health 2.0 Conference this week.
Raw information -- the gathering of it, collating, crunching and ultimately putting it to work -- was a major theme of this year's event.
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Health 2.0 poised to 'change the world'

September 27, 2011 | Patty Enrado, Special Projects Editor
SAN FRANCISCO – “Health 2.0 has the promise to change the healthcare industry,” the conference’s opening keynote speaker Mark Smith, president of the California HealthCare Foundation, told the audience on Monday.
Smith also asserted that health reform is necessary for innovation and vital to the success of Health 2.0 entrepreneurs’ business model because the current system is set up to pay for volume.
Launched in 2007, Health 2.0, stages an annual conference focused on innovation and on tools aimed at helping consumers manage their health and connect to care providers.
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Thursday, September 29, 2011

Pharmacists Offer an Rx for Health Communication

A company set up to handle prescription orders could be the key to the health-care Internet.
How difficult is it for doctors to share patient information electronically? Apparently pretty difficult: when a clinic in Minnesota managed to transmit some immunization records to the local public-health department this year, the U.S. government trumpeted the feat in a press release.
U.S. doctors and hospitals are on their way toward adopting electronic patient records for all Americans. After that, the next step in electronic medicine will be to create "health information exchanges." Imagine that wherever you go, your electronic health record will follow, preventing doctors from unnecessarily repeating a test or prescribing a drug you are allergic to. That could save a lot of money, considering that as many as 30 percent of laboratory tests are repeated because doctors don't have access to patients' earlier results.
Yet today U.S. doctors and hospitals struggle to exchange even basic patient information electronically. The reasons include laws protecting patient privacy. But most of all, the problem is that exchanging data hasn't been in anyone's economic interest. "The problem with information exchange is not the technology—it's around the business case," says Farzad Mostashari, the federal government's coördinator for health information technology. Hospitals and doctors simply don't see much economic reason to share information with competitors, or even to avoiding repeating tests.
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09/28/2011 | 03:50 am

iSOFT Group Limited : iSOFT to Supply Hospital Information System for National Brunei Electronic Medical Record (EMR) Rollout

iSOFT to Supply Hospital Information System for National BruneiElectronic Medical Record (EMR) Rollout28 September, 2011, Brunei Darussalam – Medical staff in Brunei can now look forward to using a fully digital healthcare system, following signing of an agreement to deliver the Brunei Healthcare Information System (Bru-HIMS). iSOFT, a CSC company, will supply the iSOFT Enterprise Management solution, a hospital information system widely used in the South East Asian region.
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MPA report on NPfIT riddled with errors

27 September 2011   Jon Hoeksma
The Cabinet Office has published its Major Projects Authority’s review of the National Programme for IT in the NHS, but the heavily redacted document contains some highly significant factual errors and omissions.
The report formed the basis of the government’s announcement that the programme was to be “dismantled” last week. It actually presents a more detailed and nuanced assessment than the announcement might have suggested.
But it is riddled with errors, misspells the names of many trusts, and provides only a partial picture of the vendors supplying the NHS IT market.
On the key patient administration system suppliers it states: “There is only a limited number of alternative suppliers to Cerner and iSoft’s existing product ranges, with only McKesson and GE Healthcare ready to use within the NHS trusts.”
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Arizona embarks on state HIE

September 27, 2011 | Molly Merrill, Contributing Editor
Arizona joins the ranks of states creating health information exchanges.
HINAz is an Arizona not-for-profit that began through the work of Southern Arizona Health Information Exchange and Arizona Medical Information Exchange. The two entities joined together to build a more comprehensive HIE for Arizona
The Health Information Network of Arizona (HINAz) and OptumInsight have partnered to create a statewide health information exchange network in Arizona. HINAz will implement the Axolotl HIE platform from OptumInsight to build the HIE infrastructure to enable the sharing and exchange of clinical data from all available sources across the state – improving access, quality and safety of health care while reducing and stabilizing costs.
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Issue Date: October 2011
Staying on Your Feet
CIOs Ponder the Right Formula for Disaster Preparation in the New Healthcare IT World
by John Degaspari

EXECUTIVE SUMMARY:

CIOs are hard at work coming up with the most effective and affordable strategies for protecting electronic data as their hospitals move forward on electronic medical records. While the rise of cloud computing and declining network costs are offering new opportunities in dealing with potential disasters, many find there is no substitute for good planning and constant testing.
Ask any hospital CIO what keeps him or her up at night, and chances are that disaster preparedness ranks high on their lists. In fact, as this issue was about to go to press, Hurricane Irene roared up the Eastern Seaboard, causing massive flooding in coastal cities and towns from the Carolinas to Maine. As if to underline the seriousness of the threat, New York City officials took the unprecedented step of shutting down that city's mass transit system and ordering the evacuation of four major hospitals that were located in flood areas.
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IT Executives Reject Meaningful Use Metadata Standards

The College of Healthcare Information Management Executives (CHIME) has asked HHS not to include metadata standards to support Meaningful Use Stage 2.
By Nicole Lewis,  InformationWeek
September 26, 2011
The College of Healthcare Information Management Executives (CHIME) has rejected the idea that metadata standards be included in the next notice of proposed rulemaking to support Meaningful Use Stage 2, saying more work needs to be done to verify these standards before they are implemented and used across the healthcare provider community.
CHIME's comments were delivered in a September 21 letter to Department of Health and Human Services' secretary Kathleen Sebelius, in which the organization chided HHS over plans to include metadata standards in Meaningful Use Stage 2, and expressed doubt that healthcare stakeholders are fully onboard with the decision to use the HL7 CDA R2 header to support metadata standards.
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Mapping the future of NwHIN

September 26, 2011 | Tom Sullivan, Editor
Playing the role of sometime-cartographers, healthcare policymakers and stakeholders have been working for several years to draft a new kind of national roadmap.
Known as the Nationwide Health Information Network (NwHIN), this map will someday connect communities – not with roads and bridges, but through technology that enables healthcare providers to span borders and share patient data.
Each state, however, has developed its own regulations for how health information can be stored and shared. And while the goal is to develop an information network that will enable the exchange of patient data throughout the nation, there may be as many paths to achieving that end as there are state-designated HIEs. 
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Tuesday, September 27, 2011

The Two-Way Street of Patient Engagement in Health IT

In 2005, President George W. Bush channeled Harry Truman's "chicken in every pot" moment saying that "within 10 years, every American must have a personal electronic medical record." That vision is coming into view under President Obama. HHS has undertaken a major push to get U.S. citizens to understand the concept and value of electronic health records.
As that old "Field of Dreams" effect goes, "If you build it, they will come." But, will patients really want to engage with health IT?
Consumers Want Online Health Data Access
Consumer surveys conducted in the past 12 months show most U.S. adults are interested in various aspects of electronic health information. Three-quarters of people would use a secure online tool to make it easier to communicate with the doctor's office, according to an Intuit poll conducted in January 2011. Furthermore, one-half of those interested in online access to doctors would consider switching doctors to one whose office offered secure online access.
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Doctors turn to tablet computers

Monday, September 26, 2011
Patients at Dr. Surinder Saini's office are no longer given a clipboard upon arrival. Instead, they're handed an iPad, where they tick off symptoms and allergies with the touch of a finger.
A nurse uses her own iPad to plug in vital signs. In the exam room, Saini summons the data by tapping on his tablet and is aided by a list of likely diagnoses for, say, abdominal pain.
"Most patients are amazed," said the Newport Beach (Orange County) gastroenterologist. After the visit, Saini dictates his notes about the patient straight into the iPad, where they're instantly transcribed and stored with other records.
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HHS seeks input on database for comparative-effectiveness research

Posted: September 25, 2011 - 12:01 am ET
HHS has published a formal notice and opened a 60-day public-comment period on a proposal to create a database of healthcare claims information for comparative-effectiveness research.
According to a posting in the Federal Register (PDF), the database project represents “a private/public partnership with the goal of consolidating access to longitudinal data on health services financed by both public and private payers to help facilitate” comparative-effectiveness research.
Data will be drawn “from multiple sources” to afford “adequate coverage of priority patient populations, less common medical conditions, healthcare interventions, and geographic areas,” the HHS statement said.
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Epic, Cerner top list of ACO-ready vendors

September 21, 2011 — 3:29pm ET | By Ken Terry
Epic and Cerner are the health IT vendors that have the best technology solutions for healthcare systems that aim to form accountable care organizations, according to providers surveyed by KLAS, the Orem, Utah-based research firm. But KLAS' press release emphasizes that "there are no one-stop shops for providers' ACO IT needs, especially since each ACO will be different."
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UCSD CIO: Health IT won't work unless providers understand its value

September 23, 2011 — 6:15pm ET | By Ken Terry
The University of California San Diego Health System (UCSD) recently received a rare honor: HIMSS Analytics gave UCSD a Stage 7 award, which means that it has reached the highest level of advancement in electronic health records. 
Only 60 hospitals and health systems in the U.S. have achieved this recognition, and no wonder: to do so, an organization must have a complete EHR system, including computerized physician order entry, physician and nursing documentation, closed loop medication administration, clinical decision support, ancillary systems, a data warehouse, and the ability to exchange information with other healthcare systems.
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Are certifications less crucial for healthcare IT jobs?

Some certifications can be baseline requirements for healthcare organizations

September 20, 2011 (Computerworld)
By Lucas Mearian
Timothy Stettheimer, CIO for St. Vincent's Health System in Birmingham, Ala., has more confidence in IT certifications than in referrals and in-person interviews when it comes to hiring.
"How do you know you're hiring a good person? You can get a referral, but so what? Someone can interview well, but so what? How do you really know?" Stettheimer said. "But when you can say, 'I've hit these [IT education] targets,' that shows a commitment to advancement."
He admits that some certifications get a bad rap, and are seen as useless or too granular. "I mean, how many Cisco certifications are there out there? I've lost count now. It's great for a technology-specialist-level profession, but for a leadership profession, it's not so helpful," he said. But Stettheimer believes that if you're not growing professionally, you're not doing your job.
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Market Share for Remote Patient Monitoring: $7.1 Billion

HDM Breaking News, September 23, 2011
A new report from medical market research firm Kalorama Information pegs the U.S. market value for remote patient monitoring at $7.1 billion, with annual growth averaging about 25 percent and a $22.2 billion market by 2015.
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Report: Your medical records probably aren't secure

By Emily Greenhalgh
Created 09/23/2011 - 10:26

September 23, 2011 by Emily Greenhalgh

The health care industry is ill prepared to protect patients' medical records as new uses for data arise, according to a report by PricewaterhouseCoopers LLC.
Most health organizations aren't ready to protect patient data as access to confidential patient records expands, according to a PricewaterhouseCoopers report.
As new uses for digital patient information grow, according to PwC, health organizations need to step up their act to make sure their patient information doesn't fall into the wrong hands.
Old privacy and security controls aren't thorough enough to comply with existing privacy laws and patient consent agreements, according to the report, which recommends that organizations adopt a more integrated approach to protecting patient privacy.
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Speech recognition leads to imaging report errors, study says

September 22, 2011 | Molly Merrill, Associate Editor
TORONTO – Breast imaging reports generated using an automatic speech recognition system are nearly six times more likely to contain major errors than those generated with conventional dictation transcription, a new study finds.
The study reviewed 615 reports of complex cases discussed on multidisciplinary team rounds: 308 reports generated with automatic speech recognition (where the radiologist dictates the report and software immediately transcribes the report on a computer screen) and 307 reports generated with conventional dictation transcription (where the radiologist dictates the report and a team transcribes and reviews the report).
"Our study found that at least one major error was found in 23 percent of automatic speech recognition (ASR) reports compared to 4 percent of conventional dictation transcription report," said Anabel Scaranelo, MD, of the University Health Network in Toronto.
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VA Tests Nationwide Health Information Exchange

A six-month pilot project that connects the VA with military and private providers may finally turn health data exchange into a national priority--if it works.
By Ken Terry,  InformationWeek
September 23, 2011
The VA has joined forces with military and private-sector healthcare providers in a pilot project that tests the value of using the Nationwide Health Information Network (NHIN) to share data among providers that care for veterans and active military personnel.
The project, if successful, could lead to a national rollout of the platform, which is a key part of the Virtual Lifetime Electronic Record (VLER). But Joseph Paiva, VLER project director in the VA's Office of Information Technology, told InformationWeek Healthcare that even if the rollout gets the green light, the evolution of private health information exchanges will determine how quickly the VLER linkage spreads.
The VLER is designed to facilitate the sharing of medical, benefits, and administrative data between the VA and the Department of Defense healthcare systems. The demonstration will begin on October 1 and will run through March 31, 2012.
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Monday, September 26, 2011

Nine E-Medicine Stocks

Our list of publicly traded companies that could benefit from the e-medicine revolution includes IBM and WebMD.
Medicine is still largely a cottage industry. Most doctors work in small practices where records are kept on paper. But now technology is starting to reshape this industry. The spread of electronic patient records, heavily promoted by government subsidies, will energize companies in such diverse fields as cloud computing, mobile phones, and even artificial intelligence.

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Enjoy!
David.

Friday, October 07, 2011

This Is Really Quite An Interesting Perspective on Electronic Health Records. Substantial Truth Here I Think.

One clinician explores the reasons take up seems a little slow in the US.
Tuesday, September 27, 2011

Why Doctors Don't Like Electronic Health Records

A physician argues that electronic patient records raise costs, decrease patient visits, and make poor communication tools.
Why are doctors so slow in implementing electronic health records (EHRs)?
The government has been trying to get doctors to use these systems for some time, but many physicians remain skeptical. In 2004, the Bush administration issued an executive order calling for a universal "interoperable health information" infrastructure and electronic health records for all Americans within 10 years. And yet, in 2011, only a fraction of doctors use electronic patient records.
In an effort to change that, the Obama economic stimulus plan promised $27 billion in subsidies for health IT, including payments to doctors of $44,000 to $64,000 over five years if only they would use EHRs. The health IT industry has gathered at this multibillion-dollar trough, but it hasn't had much more luck getting physicians to change their ways.
What is wrong with doctors that they cannot be persuaded to adopt these wondrous information systems? Everybody knows, after all, that the Internet and mobile apps, powered by Microsoft, Google, and Apple and spread by Facebook, Twitter, YouTube, and the iPhone and iPod, will improve care and cut costs by connecting everybody in real time and empowering health-care consumers.
I suspect the answer may lie partly in something essayist E. B. White said about humor. "Humor," said White, "can be dissected as a frog can, but the thing dies in the process, and its innards are discouraging to any but the pure scientific mind." Similarly, humanity withers when it is dissected and typed into an EHR. As Jerome Groopman, a Harvard internist, wrote in How Doctors Think, "Clinical algorithms can be useful for run-of-the-mill diagnosis and treatment ... but they quickly fall apart when doctors need to think outside their boxes, when symptoms are vague, or multiple and confusing, or when test results are inexact."
The computer is oversold as a tool to improve health care, implement reform, cut costs, and empower patients. The reasons are obvious to anyone who treats patients. You cannot look a computer in the eye. You cannot read its body language. You cannot talk to an algorithm. You cannot sympathize or empathize with it. 
We physicians are not Luddites or troglodytes. We are savvy about using the Internet, technology applications, and social media. For us, medicine mixes art and science. What we seek from patients are clues, constellations of signs and symptoms, and stories. We choose not to be reduced to data-entry clerks sorting through undigested computer bytes.
A string of numbers containing demographic, laboratory, and other patient information, no matter how systematically assembled or gathered, is not narrative. It does not tell a story. It contains "just the facts," as Sergeant Joe Friday used to say. That is why an ophthalmologist told me that when he gets an EHR summary, he ignores it: "It does not tell me the patient's story. It does not tell me why the patient is here, what troubles the patient, and what the referring doctor wants me to do."
.....
Richard L. Reece is a retired pathologist and the author of The Health Reform Maze: A Blueprint for Physician Practices. He blogs about health reform, medical innovation, and physician practices at medinnovationblog.blogspot.com


More here:

http://www.technologyreview.com/business/38490/

This comment really fits with the point I have made on this blog about just how hard it is to actually represent, and then store, the clinical thought processes.

My take is that there is a lot of underestimation of just how hard and complex the EHR task actually is and until that is clearly recognised we will all struggle to make major progress.

We certainly have a fair bit of work to do in this domain before we can be satisfied we have the problem solved.

David.

Wrap Up On the Cancellation of the UK NPfIT. A Set of Links To A Range of Perspectives.

First we have:

U.K. Ends Health-Service IT Upgrade

By JEANNE WHALEN

The U.K. said it was scrapping a £11 billion ($17 billion) information-technology program for its state-run health service, saying that some of the £6.4 billion already spent has been wasted and that the program today "is not fit to provide the modern IT services" the health-care system needs.
Launched in 2002 under the previous Labour government, the program was hailed as one of the biggest IT projects ever attempted. It aimed to digitize patient records and link all parts of the sprawling National Health Service, or NHS, and was closely watched by other countries attempting to adopt new healthcare IT. BT Group PLC and Computer Sciences Corp. are among the suppliers involved.
The scrapping of the ambitious U.K. program could have implications for the digital health-care push under way in other countries, including the U.S., which has suffered its own setbacks as it attempts to digitize medical records. Supporters of modern health-care IT say it can cut costs and improve patient care, but the software is often expensive, complex to design and cumbersome for physicians to use.
In a statement Thursday, Britain's Department of Health said it was "dismantling" the project because it "has not and cannot deliver to its original intent." It said future IT decisions would be made on a regional level, with more suppliers competing for contracts.
The health department said it based its decision in part on a recent report from a parliamentary committee that scrutinizes government spending, which concluded that the government had overpaid for parts of the IT system and faced "extensive delays" from suppliers.
.....
In the U.S., the government has tried to incentivize managed-care organizations to adopt better health-care IT as a means to improve patient care and reduce health-care spending, which the government helps fund through its Medicare and Medicaid programs. But progress has been mixed, said Kenneth Kizer, head of the Institute for Population Health Improvement at the University of California, Davis.
Managed-care groups sometimes design IT systems without enough input from doctors and nurses, who then rebel when the product is forced upon them, he said.
Managed-care giant Kaiser Permanente took a $442 million write-off in 2002 after scrapping a multibillion dollar attempt to create its own electronic medical-record system and has spent billions more on a new one. A Kaiser spokesman said the first system "was out of date and could not provide a common platform organization-wide that could operate at such great scale."
Full article here:
Then we have:

Dismantling NHS computer scheme could cost more money

Dismantling Labour’s disastrous £12billion NHS IT programme may cost taxpayers more than keeping it going.

6:00PM BST 22 Sep 2011
Ministers announced on Thursday that they will speed up the scrapping of the National Programme for IT after a review concluded “there can be no confidence that the programme has delivered or can be delivered as originally conceived”.
It confirmed earlier reports that the central part of the scheme, allowing NHS staff across England to access any patient’s details, was unworkable while costs had increases and deadlines were missed.
The governance board of the programme will now be scrapped, and local trusts will be given the freedom to develop their own versions of the electronic care record rather than having the rules dictated by Whitehall. A new Cabinet Office oversight committee will monitor future IT investment to ensure money is not wasted.
But many trusts across England have large contracts with private suppliers to supply their care record systems, and their cancellation could leave taxpayers even more out of pocket.
The Department of Health’s own chief information officer, Christine Connelly, told MPs on the Public Accounts Committee in May that a £3bn deal with CSC to deliver systems in the north, midlands and east of England would cost more to get out of than to keep going.
She said: “Potentially, if you ask me about the absolute maximum, we could be exposed to a higher cost than the cost to complete the contract as it stands today.”
More here:
We also have a good deal of coverage from E-Health Insider (www.ehi.co.uk)
First here:

Government axes "Labour" NPfIT

22 September 2011   Lyn Whitfield
The government has used the end of the Cabinet Office’s review of the National Programme for IT in the NHS to announce that it is going to “axe” the project.
The timing of the move appears to be linked to the party conference season. The Labour Party is meeting next week, and this morning a number of Conservative-supporting papers put significant emphasis on the programme's Labour roots.
The Daily Mail opens its coverage by saying that “ministers are to axe Labour’s disastrous £12 billion NHS computer scheme” which it goes on to describe as a “monument to Whitehall folly during Labour’s 13 years in power.”
The paper does not say what will happen to NHS Connecting for Health, the agency that runs the programme, or to CSC’s local service provider contract for the North, Midlands and East of England, on which considerable sums of money are still to be spent.
However, eHealth Insider understands that in line with previous announcements, the future of CfH will be clarified in a report on the future of health informatics that is due later this autumn.
EHI also understands that the DH continues to lead on negotiations with CSC, although there will be further involvement from the Cabinet Office.
Cabinet Office minister Francis Maude will chair an 'oversight committee' to get best value from the contracts, with DH and Cabinet Office representation.
The DH and the US company have been locked in negotiations about a new deal since CSC missed another key deadline to install iSoft’s Lorenzo software at Pennine Care NHS Foundation Trust.
The deal has been interrupted by a highly critical National Audit Office report on the detailed care records elements of the national programme.
This also criticised the deals re-signed with BT for London and parts of the South, which delivered less functionality to fewer trusts for only a small amount less money.
The CSC negotiations were also interrupted by a lively meeting of the Commons’ public accounts committee on the report, and a review of the whole national programme by the Cabinet Office’s Major Projects Authority.
The Mail and other papers report that, in line with changes already announced last year by health minister Simon Burns, the programme will be replaced with regional initiatives and trusts being given more control over their own IT.
In a formal press release, issued onto its website at 9.30am this morning, the DH indicates that the Major Projects Authority came to many of the same conclusions as its own review, which led to Burns' statement last summer.
It says: "The MPA found that there have been substantial achievements which are now firmly established, such as the Spine, N3 Network, NHSmail, Choose and Book, Secondary Uses Service and Picture Archving and Communications Service.
And here:

DH and Intellect to stimulate market

22 September 2011   Lyn Whitfield
The Department of Health is to work with Intellect to stimulate the market for NHS IT, following this morning’s announcement that the national programme is to be “dismantled.”
A press release issued by the DH this morning says that a new partnership will “explore ways to stimulate a market place that will no longer exclude small and medium sized companies from participating in significant government healthcare IT projects.”
In response, Intellect issued a statement saying that it wanted the DH to focus on helping the market to deliver interoperable systems and to develop a "central focus on clinical information sharing in the NHS Information Strategy."
To support these moves, Intellect has published a paper - 'We should talk - interoperability and the NHS' - setting out a number of recommendations for helping the NHS to share clinical information more effectively.
The paper's principal authors, Paul Cooper and Martin Whittaker, said that  NHS Connecting for Health, suppliers and trusts should work together to improve the Interoperability Toolkit programme; which has just reached its second iteration.
They argued that for the benefits of ITK to be realised, the NHS will need to make it a central plank of its promised information and technology strategies.
They said it would also need to "evangelise" the benefits to business and clinical leaders, and to engage with suppliers so it becomes an "encouragement to succeed, not a barrier to entry." 
Lots more here:
There is also an editorial on the forward direction:

EHI Editorial

That the National Programme for IT in the NHS is to be dismantled makes a strong newspaper headline; but it leaves a host of problems for those who care about NHS IT and its role in the wider healthcare reforms. First off, much of this week's announcement is re-heated and so not as new as it looks.
Time was called on the programme last autumn, and on the surface very little appears to have changed since then. There's still a big mess with CSC in the North Midlands and East and no information strategy anywhere. However, in the corridors of Whitehall a revolution has been underway. The Cabinet Office has taken a firm grip on the CSC negotiations.
The National Programme Board is to be replaced by direct ministerial control. The Department of Health is to work with Intellect to 'revitalise' the market. If it is remotely serious, it should vigorously dismantle the monopolies created by NPfIT and take steps on certification and interoperability that would begin to reduce the barriers to market entry.
More than anything, though, the NHS needs to have some clear guidance on the future direction of its IT and what, if anything, is going to come from the remaining contracts. NPfIT may be over, again, but we will all have to live with its legacy and pay the bills for years to come.
Here is the Official Department of Health Medial Release:

Dismantling the NHS National Programme for IT

September 22, 2011
The government today announced an acceleration of the dismantling of the National Programme for IT, following the conclusions of a new review by the Cabinet Office’s Major Projects Authority (MPA). The programme was created in 2002 under the last government and the MPA has concluded that it is not fit to provide the modern IT services that the NHS needs.
In May 2011 the Prime Minister announced in the House of Commons that the MPA would be reviewing the NHS National Programme for IT. 
 The MPA found that there have been substantial achievements which are now firmly established, such as the Spine, N3 Network, NHSmail, Choose and Book, Secondary Uses Service and Picture Archiving and Communications Service.  Their delivery accounts for around two thirds of the £6.4bn money spent so far and they will continue to provide vital support to the NHS. However, the review reported the National Programme for IT has not and cannot deliver to its original intent.
In a modernised NHS, which puts patients and clinicians in the driving seat for achieving health outcomes amongst the best in the world, it is no longer appropriate for a centralised authority to make decisions on behalf of local organisations.  We will continue to work with our existing suppliers to determine the best way to deliver the services upon which the NHS depends in a way which allows the local NHS to exercise choice while delivering best value for money.
A new partnership with Intellect, the Technology Trade Association, will explore ways to stimulate a marketplace that will no longer exclude small and medium sized companies from participating in significant government healthcare projects.
The Department of Health said:
“The exchange of information between patients and clinicians and across the NHS is a fundamental part of how we are centring care on patients and making sure innovation and choice are fully supported.  The NPfIT achieved much in terms of infrastructure and this will be maintained, along with national applications, such as the Summary Care Record and Electronic Prescriptions Service, which are crucial to improving patient safety and efficiency.  But we need to move on from a top down approach and instead provide information systems driven by local decision-making.  This is the only way to make sure we get value for money and that the modern NHS meets the needs of patients.”
Francis Maude, Minister for the Cabinet Office, said:
“This Government will not allow costly failure of major projects to continue. That’s why we have set up the Major Projects Authority – to work in collaboration with central Government Departments to help us get firmer control of our major projects, and ensure there is a more systematic approach by departments as well as regular, planned scrutiny to keep projects on track.”
“The National Programme for IT embodies the type of unpopular top-down programme that has been imposed on front-line NHS staff in the past. Following the Major Projects Authority review, we now need to move faster to push power to the NHS frontline and get the best value for taxpayers’ money.”
Other comments are also included in the release:
It is interesting that there also seems to be some major aspects still going ahead:

Cabinet Office review pleads stay of execution for NHS IT

The Major Projects Authority has urged the Department of Health to persist, at least for a while, with two key features of the National Programme for IT
A team from the Cabinet Office has recommended that the Department of Health (DH) gives more time to two elements of England's NHS National Programme for IT (NPfIT) dealing with the provision of key information systems.
The Major Projects Authority (MPA), set up last year to scrutinise expensive projects throughout central government, has said the Additional Supply Capability and Capacity (ASCC) should be retained for the south of England, and that CSC should be given more time to deliver the Lorenzo system from iSoft in the North, Midlands and East area for which it is local service provider.
The recommendations are within the MPA's assessment review of NPfIT, which has been made available on the Cabinet Office website.
One of three recommendations, that the programme should be dismembered and reconstituted under different management because of so many negative perceptions, was effectively accepted by the DH last week. But the other two recommend that elements of NPfIT's plans to provide electronic patient record systems – the most problematic part of its work – should be continued, although with reservations in regard to CSC and iSoft's work introducing Lorenzo software.
The second recommendation is that ASCC, which was set up to give healthcare trusts a more flexible procurement model, should be approved for use in the southern cluster despite the Cabinet Office recently refusing to do so. The review says the solutions available through the framework are tried and tested, and that preventing its use will slow down progress in the region.
More here:
Lastly from the UK we have:

NHS software provider CSC may get cash lifeline

• Cabinet Office proposes financial aid for IT contractor
• CSC's Lorenzo system 'not proved fit for purpose', says report
Ministers are considering offering one of the NHS's worst-performing IT contractors financial help to keep the company from ditching a troublesome software package which is "not fit for purpose", according to Cabinet Office documents.
The plan to offer the US group Computer Sciences Corporation (CSC) one last chance to fix the software risks a furious backlash over "payments for failure", in the latest twist to a fiasco that has generated years of delays at considerable cost to the health service.
The move comes despite the Department of Health last week declaring that the £11.4bn National Programme for IT, started in 2002 under Labour, was to be scrapped because it was "not fit to provide the modern IT services that the NHS needs".
However, the department has not severed existing contracts. Most controversially, it remains in a long-running feud with CSC over a £3bn agreement to install IT systems in the Midlands, north and east of England.
More here:
From the US here is the last comment I have spotted:
September 27, 2011, 7:40 am

Lessons From Britain’s Health Information Technology Fiasco

By STEVE LOHR
Government press releases tend to be bland, earnest blather. But not one posted on the British Department of Health’s Web site last Thursday. Its headline: “Dismantling the NHS National Programme for IT.”
To translate the acronyms a bit, the NHS is Britain’s state-run National Health Service and the program in question was the ambitious drive to computerize England’s health records and let doctors, clinics and hospitals share patient information electronically. The project, begun in 2002, was budgeted at £12 billion (about $19 billion) and the government hailed it as “the world’s biggest civil information technology program.”
The British digital health project has been a slow-motion train wreck for some time with last week’s announcement mainly confirmation — and a pledge to change course. (The announcement was also a political gesture, as the Conservative government of David Cameron tries to get as much distance as it can from an unpopular initiative, begun by Tony Blair’s Labor government.)
More here:
At the end of the day I believe this initiative will leave a considerable legacy and a vast array of lessons which will need years to really appreciate.
One feels it might just have been a little too big to pull off - and it will be years down the track before we know if the alternative approaches do ultimately deliver!
Time will tell.
David.

Thursday, October 06, 2011

Health Information Exchange Where Are the Roadblocks. The Scene Is As Hard In Australia. We Now Have Some Late Breaking PCEHR Standards News!

The following useful review of the barriers to Health Information Exchange appeared a few days ago.

The Top 5 roadblocks HIEs face

September 28, 2011 | GHIT Staff
Just as young businesses of most any sort must circumvent myriad challenges to succeed, health providers are encountering multiple roadblocks in the implementation of HIEs. At the core of those: financial sustainability. The root of many, perhaps, money is neither the only problem, nor the most trying.
“The most important obstacles facing HIEs depend on the perspective of who is looking at them – the patients, the providers, etc. So as we move forward, we have to make sure to address all these stakeholders,” said Benjamin Stein, MD, president and CEO of HIE Long Island Patient Information eXchange (LIPIX). “There is no one-size-fits-all answer to the problems of HIEs.”
Indeed, many healthcare professionals have raised doubts about HIEs living up to their potential. A survey of healthcare providers, vendors and experts found five issues that constitute the top concerns.
1. Data sharing
The groundwork already in place, with federal incentives for EHRs, HIEs, telemedicine, and related projects available, the goals of HIEs are straightforward: Reduce administrative costs associated with manual data and paper-based systems, reduce costs related to improved information access by decreasing redundant testing, avoidance of unnecessary hospitalizations due to missing information, more efficient visits, improving co-ordination of patient care with timely and accurate information across providers, and more effective medication reconciliation.
That all comes down to actually exchanging health data.
As HIEs now stand, however, much of their operations still occur in narrow sets of silos. Data exchange between EHRs and exchanges through organized state and regional HIEs is decidedly uneven in delivery. Electronic reporting for public and population health measurement is lacking.
2. Patient consent
Patient authorization and consent is often cited as one of the first challenges to HIEs, because authorization is a true test of the ability of EMR systems to work across healthcare and technology platforms as data is exchanged.
At Geisinger Health System, a Danville, Pa.-headquartered provider, Jim Younkin is program director of IT, leading development of the Keystone Health Information Exchange (KeyHIE), a regional HIE.
“Our legal counsel reminds us of the risks, and to make sure we don’t share information with anyone unless we have patient authorization allowing it to be shared,” Younkin said. “So we have increased our efforts in obtaining authorization, but that’s not easy.”
KeyHIE includes 12 hospitals, more than 90 clinics, skilled care, long-term care, and home health organizations. More than 385,000 patients have signed authorizations, allowing their information to be shared for treatment purposes through this exchange. Nonetheless, Yonkin says patient authorization and consent remain a hurdle to further development of HIEs.
“Because we have a large footprint,” Younkin adds, “a lot of doctors see patients who have records from other hospitals, where in some cases the information comes back in faxes. That’s been a difficult issue for us.”
Having started an EMR system in 1996, Geisinger is a seasoned user of technology platforms to facilitate date exchange, and is continuing its search for best practices in patient authorization, Younkin added
Likewise, Patty Dodgen, CEO of Tampa, Fla.-based Hielix, which provides HIE implementation services, sees difficulties in adopting patient authorization on the large scale contemplated by HIEs.
“There is a maze of EHR vendors touting, not an HIE system, but an interface. You have to have functionality that includes a mechanism for verifying and authenticating individuals and a record location service,” Dodgen explained. “You have to build an HIE that includes functionality that can go into a variety of settings and pull information back into the user.”
3. Standards
LIPIX CEO Stein believes HIEs need to bring in as many stakeholders – doctors, providers, patients – as possible from the very beginning, particularly to settle differences of healthcare standards that might prevent integration.
“The complexity of the healthcare IT market creates a challenge in relation to standards. All the vendors have their own standards,” Stein explained. “I think we can overcome that but it’s going to take a focus on development of core standards, some key standards.”
Lots more here:
There is little doubt that after getting a properly functional EHR in place the next step for most health care providers is to be able to gather information regarding the patient in front of them from all the useful information sources that can be accessed. This may be in the form of test result information, specialist and hospital record information or whatever else can be safely and reliably located.
Actually organising a then managing such exchange is no trivial task, but with some effort and co-operation is certainly possible.
The issues of what actual information is shared, how consent is managed, what standards are used, how complexity is kept as low as possible and so on are all vitally important as is the critical issue of how the exchange can be sustained in the longer term (i.e. who pays for what etc.).
With all this activity in the US it is important to recognise that Australia has developed a pretty effective health information exchange infrastructure based on a small charge being paid for the practitioner for connectivity (and some state-wide arrangements).
The figures for adoption and use are actually pretty impressive. As an example Medical Objects now has about 17,000 health practitioners connected with secure clinical messaging.
See here:
There are a range of other providers (e.g. Argus, HealthLink proMedicus etc. with varying capabilities and functionality) and between these providers most GPs have access to such health information exchange if they desire (and most do).
A point to note here is that all this activity and success has been had despite rather than because of NEHTA’s efforts. To date adoption of NEHTA’s offering in the secure messaging area has been very low indeed.
According to the NEHTA Secure Messaging Site this effort has been underway since 2006
To date it is not clear - after 5 years - just how many sites are using it compared with the providers mentioned above but I doubt it would be 1% of those using other systems.
The software compliance list to NEHTA Standards does not seem to have been updated since March 2010 and it is by no means clear what has happened here either. I would love to hear from active users out there to get a handle for all of us as to just where all this is up to!
-----
After this was written - and just in the last day we have these 2 files become available:
and here:
These two documents are the analysis that supported the earlier reported NEHTA standards choices for the PCEHR and the until quite recently unavailable Direckt Report on what the available choices were.
Those cleverer than I can analyse in detail but it does rather look that there are at least some changes of direction in some areas with other areas still going with approaches that are unproven and unimplemented in Australia. This will keep the developers busy!
The big question is, of course, how all these proposals fit with the infrastructure Medical Objects, Argus, HealthLink and others have in place. Replacement of what already is in place is a multi-year and expensive activity at best and total lunacy at worst! Comments on that issue welcome.
David.